Figure 525

Frequency of systemic effects. The most frequent systemic manifestations of renal cell cancer are noted [55]. Other paraneoplastic and systemic manifestations include liver function abnormalities, high-output congestive heart failure, and manifestations of the secretion of substances such as prostaglandins, renin, glucocorti-coids, and cytokines (eg, interleukin-6). At presentation, a small percentage of tumors are bilateral, while nearly a third of patients have demonstrable metastatic disease, which may occur in virtually any organ. Most common sites of metastases include lung, bone, liver, and brain. ESR—erythrocyte sedimentation rate. (From Chisholm and Roy [55]; with permission.)